Platelet IIb/IIIa antagonists followed by delayed stent implantation. A new treatment for vein graft lesions containing massive thrombus.

Abstract

The percutaneous treatment of saphenous vein graft lesions containing angiographically massive thrombus is associated with a high risk of distal embolisation and no-reflow. The optimal management for these lesions remains unclear and a challenge to the interventional cardiologist. Five cases are described in whom the risks of percutaneous angioplasty were felt to be excessive owing to a high thrombus load. Each case was treated with a bolus and infusion of abciximab (ReoPro; Eli Lilly-a platelet glycoprotein IIb/IIIa receptor antagonist) at least 24 hours before further angiography. Repeat angiography of the culprit vein graft, following treatment with abciximab alone, demonstrated a major reduction in the thrombus score and the presence of TIMI 3 flow in each case. Immediately following repeat angiography, angioplasty with stent insertion was performed successfully with no distal embolisation or no-reflow phenomenon. This staged approach, with abciximab used alone to reduce thrombus load, is a new treatment for vein graft lesions containing massive thrombus.

• Authors: N Robinson, K Barakat, D Dymond
• Journal: Heart (British Cardiac Society) (Heart) Vol. 81 Issue 4 Pg. 434-7 (Apr 1999) ISSN: 1355-6037 [Print] England
• PMID: 10092575 (Publication Type: Journal Article)

Chemical References

• Antibodies, Monoclonal
• Immunoglobulin Fab Fragments
• Platelet Aggregation Inhibitors
• Abciximab

Topics

• Abciximab
• Aged
• Angioplasty, Balloon, Coronary
• Antibodies, Monoclonal (therapeutic use)
• Combined Modality Therapy
• Coronary Angiography
• Female
• Graft Occlusion, Vascular (diagnostic imaging, drug therapy, therapy)
• Humans
• Immunoglobulin Fab Fragments (therapeutic use)
• Male
• Platelet Aggregation Inhibitors (therapeutic use)
• Stents
• Thrombosis (diagnostic imaging, drug therapy, therapy)